Jai Bhavani Shikshan Prasarak Mandal's INSTITUTE OF PHARMACY

Photograph of student
1.
Name (As it appears on HSC/Equivalent Marksheet)
Father's Name
Mother's Name
Religion
Nationality
2.
Permanent address
Tal.
Dist.
State
Area (Urban/Rural)
Pin code
Contact No
3.
Gender		Male Female
Date of birth
Place of birth
State of Domicile
Caste
4.
Details of previous Exam
Xth Board or Equivalent (Name)
Marks secured in SSC (Std. X) Exam
Grand Total Marks Secured
Maximum Marks
5.
XIIth Board or Equivalent (Name)
Marks secured in HSC (Std.XII) Exam

Subject	Max. Marks		Marks obtained
Physics	100
Chemistry	100
Biology	100
Mathematics	100
PCM Total	300
PCB Total	300
XII or HSC Grand total	600

Date
Name & Signature of candidate